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Category 8 - MISCELLANEOUS SERVICES
80165 - Additional Information
Professional attendance at a place other than consulting rooms.
As per the social worker service requirements outlined for item 80160.
Fee: $124.75 Benefit: 85% = $106.05
(See para MN.7.1 of explanatory notes to this Category)
Category 8 - MISCELLANEOUS SERVICES
Provision of Individual Focussed Psychological Strategies Services by Allied Health Providers - (Items 80100 to 80165)
This note provides information on Individual Focussed Psychological Strategies services delivered by allied health providers, and is also applicable for video and phone equivalent MBS items. It includes an overview of the items, patient and provider eligibility, what activities are involved in providing services rebated by these items, and additional claiming information.
For information on Group Focussed Psychological Strategies services see MN.7.4.
The Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative commenced on 1 November 2006. Under the Better Access initiative MBS items provide Medicare benefits for the following allied mental health services:
- psychological therapy - provided by eligible clinical psychologists; and
- focussed psychological strategies – allied mental health - provided by eligible psychologists, occupational therapists and social workers.
FOCUSSED PSYCHOLOGICAL STRATEGIES – ALLIED MENTAL HEALTH SERVICES ATTRACTING MEDICARE REBATES
Eligible focussed psychological strategies services
There are 24 MBS items for the provision of individual focussed psychological strategies (FPS) - allied mental health services to eligible patients by allied health professionals:
- 80100, 80105, 80110 and 80115 for provision of FPS services by a psychologist;
- 91169, 91170, 91183 and 91184 for provision of video conference and phone FPS services by a psychologist;
- 80125, 80130, 80135 and 80140 for provision of FPS services by an occupational therapist;
- 91172, 91173, 91185 and 91186 for provision of video conference and phone FPS services by an occupational therapist;
- 80150, 80155, 80160 and 80165 for provision of FPS services by a social worker; and
- 91175, 91176, 91187 and 91188 for provision of video conference and phone FPS services by a social worker.
The allied health professional must meet the provider eligibility requirements set out below and be registered with Services Australia.
In these notes, ‘GP’ means a medical practitioner, including a general practitioner, but not including a specialist or consultant physician.
Services provided under the focussed psychological strategies – allied mental health items will not attract a Medicare rebate unless:
- a referral has been made by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan;
- a referral has been made by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or
- a referral has been made by a psychiatrist or paediatrician from an eligible psychiatric or paediatric service (see Referral Requirements for further details regarding psychiatrist and paediatrician referrals).
Number of services per year
Medicare rebates are available for up to 10 individual mental health services in a calendar year. The services may consist of: GP or medical practitioner focussed psychological strategies services; and/or psychological therapy services delivered by clinical psychologists; and/or focussed psychological strategies - allied mental health services.
Patients will also be eligible to claim up to 10 separate services within a calendar year for group therapy services see MN.7.4. These group services are separate from the individual services and do not count towards the individual services per calendar year maximum associated with those items.
Please note if a referral does not specify whether the referral is for individual or group therapy, the patient can use a referral to access either individual or group therapy treatment options. The patient should speak to their GP about their treatment needs and the type of treatment that might be suitable in their particular circumstances.
In the instance where a patient has received the maximum services available under the Better Access to Psychiatrists, Psychologists and General Practitioners through the Medicare Benefits Schedule initiative per calendar year and is considered to clinically benefit from some additional services, the patient may be eligible for Primary Health Networks (PHNs) funded psychological therapies if they meet relevant eligibility criteria for the PHN commissioned services. It is recommended that providers refer to their PHN for further guidance.
Service length and type
Services provided by eligible allied health professionals under these items must be within the specified time period within the item descriptor.
It is expected that professional attendances at places other than consulting rooms would be provided where treatment in other environments is necessary to achieve therapeutic outcomes.
A range of acceptable strategies has been approved for use by allied mental health professionals utilising the FPS items.
(including motivational interviewing)
2. Cognitive-behavioural therapy including:
· Behavioural interventions
- Behaviour modification
- Exposure techniques
- Activity scheduling
· Cognitive interventions
- Cognitive therapy
3. Relaxation strategies
- Progressive muscle relaxation
- Controlled breathing
4. Skills training
- Problem solving skills and training
- Anger management
- Social skills training
- Communication training
- Stress management
- Parent management training
5. Interpersonal therapy (especially for depression)
6. Narrative therapy (for Aboriginal and Torres Strait Islander people).
7. Eye-Movement Desensitisation Reprocessing (EMDR)
Course of treatment and reporting back to the referring medical practitioner
Eligible patients can claim Medicare subsidies for up to 10 individual mental health services per calendar year.
Within this maximum service allocation, the allied mental health professional can provide one or more courses of treatment (additional information on course of treatment session limits is above). This enables the referring medical practitioner to consider a report from the allied mental health professional on the services provided to the patient, and the need for further treatment.
On completion of the initial course of treatment, the allied mental health professional must provide a written report to the referring medical practitioner, which includes information on:
- assessments carried out on the patient;
- treatment provided; and
- recommendations on future management of the patient's disorder.
A written report must also be provided to the referring medical practitioner at the completion of any subsequent course(s) of treatment provided to the patient.
Out-of-pocket expenses and Medicare safety net
Charges in excess of the Medicare benefit for these items are the responsibility of the patient. However, if a service was provided out of hospital, any out-of-pocket costs will count towards the Medicare safety net for that patient. The out‑of‑pocket costs for mental health services which are not Medicare eligible do not count towards the Medicare safety net.
Individual FPS items apply to people with an assessed mental disorder and where the patient is referred by a GP or medical practitioner who is managing the patient under a GP Mental Health Treatment Plan or under a referred psychiatrist assessment and management plan; or from an eligible psychiatrist or paediatrician.
The conditions classified as mental disorders for the purposes of these services are informed by the World Health Organisation, 1996, Diagnostic and Management Guidelines for Mental Disorders in Primary Care: ICD-10 Chapter V Primary Care Version. For the purposes of these items, dementia, delirium, tobacco use disorder and mental retardation are not regarded as a mental disorder.
Checking patient eligibility for focussed psychological strategies – allied mental health services
If there is any doubt about a patient’s eligibility, Services Australia will be able to confirm whether a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan is in place and claimed; or an eligible psychiatric or paediatric service has been claimed, as well as the number of allied mental health services already claimed by the patient during the calendar year.
Allied mental health professionals can call Services Australia on 132 150 to check this information, while unsure patients can seek clarification by calling 132 011.
The patient will not be eligible if they have not been appropriately referred and a relevant Medicare service provided to them. If the referring service has not yet been claimed, Services Australia will not be aware of the patient’s eligibility. In this case the allied mental health professional should, with the patient’s permission, contact the referring practitioner to ensure the relevant service has been provided to the patient.
Publicly funded services
Focussed psychological strategies (FPS) services items do not apply for services that are provided by any other Commonwealth or state funded services or provided to an admitted patient of a hospital. However, where an exemption under subsection 19(2) of the Health Insurance Act 1973 has been granted to an Aboriginal Community Controlled Health Service or state/territory clinic, the FPS services items apply for services that are provided by eligible allied mental health professionals salaried by, or contracted to, the service as long as all requirements of the items are met, including registration with Services Australia. These services must be direct billed (that is, the Medicare rebate is accepted as full payment for services).
Private health insurance
Patients need to decide if they will use Medicare or their private health insurance ancillary cover to pay for these services. Patients cannot use their private health insurance ancillary cover to ‘top up’ the Medicare rebate paid for the services.
REFERRAL REQUIREMENTS (GPs, MEDICAL PRACTITIONERS, PSYCHIATRISTS OR PAEDIATRICIANS TO ALLIED MENTAL HEALTH PROFESSIONALS)
Patients must be referred for focussed psychological strategies – allied mental health services by either a GP or medical practitioner managing the patient under a GP Mental Health Treatment Plan or referred by a medical practitioner (including a general practitioner, but not a specialist or consultant physician) who is managing the patient under a referred psychiatrist assessment and management plan; or on referral from a psychiatrist or a paediatrician.
Referrals from psychiatrists and paediatricians must be made from eligible Medicare services. For specialist psychiatrists and paediatricians these services include any of the specialist attendance items 104 through 109. For consultant physician psychiatrists the relevant eligible Medicare services cover any of the consultant psychiatrist items 293 through 370; while for consultant physician paediatricians the eligible services are consultant physician attendance items 110 through 133.
Referring practitioners are not required to use a specific form to refer patients for these services. A referral for mental health services should be in writing (signed and dated by the referring practitioner) and include:
- the patient’s name, date of birth and address;
- the patient’s symptoms or diagnosis and a statement on whether a mental health treatment plan has been prepared;
- a list of any current medications;
- the number of sessions the patient is being referred for (the ‘course of treatment’);
- a statement about whether the patient has a mental health treatment plan or a psychiatrist assessment and management plan.
It may be useful for a referral to include a statement indicating whether group sessions could be considered.
A referral should include all of the above details, to assist with any auditing undertaken by the Department of Health and Aged Care. Where appropriate, and with the patient’s agreement, the GP can also attach a copy of the mental health treatment plan to the referral.
Number of Sessions
The referring practitioner can decide how many sessions the patient will receive in a course of treatment, within the maximum session limit for the course of treatment. The maximum session limit for each course of treatment is set out below:
- Initial course of treatment – a maximum of six sessions.
- Subsequent course of treatment – a maximum of six sessions up to the patient’s cap of ten sessions (for example, if the patient received six sessions in their initial course of treatment, they can only receive four sessions in a subsequent course of treatment).
The written report provided by the allied mental health professional following a course of treatment will be considered by the referring practitioner in assessing the patient's clinical need for further sessions after each course of treatment.
Specifying the Number of Sessions on a Referral
If the referring practitioner:
- Does not specify the number of sessions
- Specifies a number of sessions above the maximum allowed for the course of treatment
- Specifies a number of sessions above the maximum allowed for the calendar year (including any sessions the patient has already received that year)
Then the allied mental health professional can use their clinical judgment to provide services under the referral, noting the patient cannot receive more than:
- the maximum number of sessions allowed for that particular course of treatment (as set out above), and
- the maximum number of sessions allowed in a calendar year.
In these circumstances, an allied mental health professional must provide a report at the end of a course of treatment in line with standard practice for these services. This enables the referring medical practitioner to consider the treating practitioner’s report on the services provided to the patient, and the need for further treatment.
A referring practitioner can verbally refer a patient for Better Access services only if:
- in their clinical judgement they consider it is necessary for the patient to have immediate access to support from an allied mental health professional, and
- it is not practicable in the circumstances to provide a written referral – for example, to do so would cause delays in treatment to the patient’s detriment, and
- the allied mental health professional documents in writing that they are treating the patient based on the referring practitioner’s verbal referral, and
- the referring practitioner provides a written referral to the allied mental health professional as soon as possible afterwards.
While waiting for the referring practitioner to provide a written referral, the treating practitioner can provide treatment according to the verbal referral until the referred number of sessions have been completed. If there is any doubt about the number of sessions the patient was verbally referred for, the treating practitioner should follow the guidance provided above under the heading ‘Specifying the number of sessions on a referral’.
A verbal referral does not replace any requirement for the GP to review the patient’s progress (taking into account the written report from their treating allied health professional) after each course of treatment.
The allied mental health professional must be in receipt of the referral at the first allied mental health consultation. The allied health professional must also retain the referral for 2 years (24 months) from the date the service was rendered.
Use of Referrals across Different Calendar Years
Eligible patients can claim Medicare subsidies for up to 10 individual and 10 group mental health services per calendar year.
If a patient has not used all their psychological therapy services and/or focussed psychological strategies services in course of treatment covered by a referral within the calendar year, it is not necessary to obtain a new referral for the "unused" services. However, any "unused" services received from 1 January in the following year under that referral will count as part of the total services for which the patient is eligible in that calendar year.
When patients have used all of their referred services they will need to obtain a new referral from the referring practitioner if they are eligible for further services. Where the patient's care is being managed by a GP or medical practitioner, the GP/medical practitioner may choose to use this visit to undertake a review of the patient's GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan.
It is not necessary to have a new GP Mental Health Treatment Plan and/or psychiatrist assessment and management plan prepared each calendar year in order to access a new referral(s) for eligible psychological therapy services and/or focussed psychological strategies services. Patients continue to be eligible for rebates for psychological therapy services and/or focussed psychological strategies services while they are being managed under a GP Mental Health Treatment Plan and/or a psychiatrist assessment and management plan as long as the need for eligible services continues to be recommended in their plan.
Referrals for the Additional 10 Sessions (available until 31 December 2022)
In response to the COVID-19 pandemic, the number of Medicare rebateable individual mental health services was temporarily increased from 10 to 20 per calendar year until 31 December 2022.
A patient does not need a new referral to access Better Access sessions from 1 January 2023. If the patient has a current referral (either for the initial 10 sessions or the additional 10 sessions) and has not used all of the sessions, they can use that referral to access sessions in 2023. However, they cannot receive more than 10 individual sessions in 2023.
ALLIED MENTAL HEALTH PROFESSIONAL ELIGIBILITY
Eligible allied health professionals
A person is an allied health professional in relation to the provision of a FPS service if the person meets one of the following requirements:
- the person is a psychologist who holds general registration in the health profession of psychology under the applicable law in force in the State or Territory in which the service is provided;
- the person is a member of the Australian Association of Social Workers (AASW) and certified by AASW as the meeting the standards for mental health set out in the document published by AASW titled ‘Practice Standards for Mental Health Social Workers 2014’ as in force on 25 September 2014;
- the person is an occupational therapist who is registered as a person who may provide that kind of service under the applicable law in force in the State or Territory in which the service is provided; and is accredited by Occupational Therapy Australia as:
- having a minimum of two years experience in mental health; and
- having undertaken to observe the standards set out in the document published by Occupational Therapy Australia's 'Australian Competency Standards for Occupational Therapists in Mental Health' as in force on 1 November 2006.
Continuing professional development (CPD) for Occupational Therapists and Social Workers providing focussed psychological strategies (FPS) services
Occupational Therapists and Social Workers providing FPS services are required to have completed 10hours FPS CPD.
A CPD year for the purposes of these items is from 1 July to 30 June annually.
Part-time allied mental health professionals are required to have 10 hours of FPS related CPD, the same as full-time allied mental health professionals.
Occupational Therapists and Social Workers who are registered during the course of the CPD year, their obligation to undertake CPD will be on a pro-rata basis. The amount of units will be calculated from the 1st of the month immediately succeeding the month they obtained initial registration. The obligation will be one-twelfth of the yearly requirement for each month.
CPD activities must be relevant to delivering FPS services. Acceptable CPD activities where the content is related to FPS can include formal postgraduate education, workshops, seminars, lectures, journal reading, writing papers, receipt of supervision and peer consultation, and online training.
There is flexibility in the CPD activities that can be undertaken to meet individual professional needs and their practice/client base and client needs. For example, activities could also include assessment and treatment of specific disorders and client types such as youth, or different modalities and delivery such as working with groups.
Registering with the Services Australia
Advice about registering with the Services Australia to provide focussed psychological strategies - allied mental health services is available from the Services Australia provider enquiry line on 132 150.
For further information about Medicare Benefits Schedule items, please go to the Department of Health and Aged Care's website at www.health.gov.au/mbsonline
For providers, further information is also available for providers from the Services Australia provider enquiry line on 132 150.
The Services Australia has developed a Health Practitioner Guideline to substantiate that a valid Allied Mental Health service has been provided (for allied health professionals) which is located on Services Australia’s website.
- Assist - Addition/Deletion of (Assist.)
- Amend - Amended Description
- Anaes - Anaesthetic Values Amended
- Emsn - EMSN Change
- Fee - Fee Amended
- Renum - Item Number Change (renumbered)
- New - New Item
- NewMin - New Item (previous Ministerial Determination)
- Qfe - QFE Change